Heart disease is prevalent among people with schizophrenia. Patients with schizophrenia also have higher rates of diabetes and high blood pressure, and lower levels of good (HDL) cholesterol. Although factors such as smoking and lack of access to quality medical care may be two reasons for higher heart disease rates, atypical antipsychotics are known to be associated with cardiovascular side effects as well.

Gail Daumit, M.D., MHS, of Johns Hopkins University, and colleagues, assessed the effects of antipsychotic medications used in CATIE on participants’ 10-year coronary heart disease (CHD) risk. The five CATIE antipsychotics were olanzapine (Zyprexa), quetiapine (Seroquel) risperidone (Risperdal) and ziprasidone (Geodon)—all atypical antipsychotics—and the conventional antipsychotic perphenazine. At the beginning of the trial, participants had a higher estimated 10-year CHD risk compared to the general population, and had been treated with antipsychotics for an average of 14 years.

The researchers collected data on vital signs, smoking status and weight from the participants multiple times during the 18-month first phase of the trial, and found that the mean change in risk for CHD differed significantly among the medications. They found that the risk for CHD increased 0.5 percent for those taking olanzapine and 0.3 percent for those taking quetiapine. But risk decreased 0.5 percent for those patients taking perphenazine, 0.6 percent for those taking risperidone, and 0.6 percent for those taking ziprasidone, especially among participants whose risk for CHD was higher than 10 percent at the beginning of the study. The result suggests that these three antipsychotics may counteract some metabolic side effects associated with prior use of antipsychotics, according to the researchers.

Participants taking risperidone or ziprasidone also showed somewhat lower total cholesterol levels. Conversely, those taking olanzapine tended to show increases in total cholesterol levels, echoing recent studies that found large increases in triglyceride levels associated with olanzapine.

Daumit and colleagues conclude by suggesting that when clinicians are choosing antipsychotic treatment for their patients, they should consider the relative cardiovascular risks associated with each medication, especially for older patients and those with existing cardiovascular risk factors.